Developing training to support staff working with people with

Personality Disorders

Kate Sloan Nurse Practitioner in Psychotherapy

Ian Gidley Nurse Specialist in Psychotherapy

Theresa Kelly Nurse Practitioner in Cognitive Behavioural Psychotherapy

Why did we develop a short course?

• Requests

• Costs

• Not a lot available

• Stress

• Developing knowledge and skills in the workforce

Who attended?

• Nurses– Inpatient services– CMHT– Day service - rehabilitation

• Occupational Therapist– CMHT

What we did.

• Three day course over a three month period

• Each day had an element of theory

• Each day had an action component

• Day 1 & 2 day gave them a homework task

• Day 2 and 3 had reflective practice time to reflect on homework and experiential learning

What we did not want to do?

• Fact listing course

• Concrete answers

• Tell them what to do

• Present a plan

What did we aim to do?• Encourage thinking

• Help them develop their understanding

• Help them monitor the relationship

• Get them to explore their experiences

• Assist staff to understand why they experience intense feelings

• Support them to understand their choice of interventions

• Integrate with other training in the organisation

Theory• Diagnosis

• Introduction to attachment theory

• Understanding defence mechanisms

• Recognising over developed and under developed strategies

• Motivational interviewing - cycle of change

• Therapeutic relationship

• Managing boundaries

• Endings

Reflective Practice - day 2 & 3

• Allowed participants time to reflect on:

– Homework tasks

– Experiences

– Theory

– Understanding

– Explore feelings

– Share issues in a group

Action

• Action - Psychodrama techniques

• Why?

– To support theory to practice

– To explore relationship issues

– To help develop understanding of external and internal conflict

Action continued

• Scenarios:

– patient

– practitioner

– observer

• Action method:

– process

• De-rolling & sharing

Importance of balancing theory and practice

• Deeper understanding - engaging with the practitioners own experience

• Problem based learning/experiential - in vitro/bringing it alive

• Highlights complexity and importance of the therapeutic relationship

Group Evaluation

• Group discussion evaluation at end of each day

– What went well?

– What did not go well?

– What have you learned today?

Pre & Post Evaluation of the Workshops

• Three basic questions about demographics

• Ten questions requiring completion of self assessed level of knowledge/skill using Likert scales

• Five multiple choice questions about attitude

• Three basic questions about training, venue & presentations

Evaluation results

• Ten question Likert Scale

– demonstrated an increased knowledge and understanding of personality disorders

– increased confidence to recognise issues and manage the therapeutic relationship

– improved ability to recognise early warning signs and assist the patient manage relapse

Attitude

• Multiple choice - attitude

– this showed a pre & post uncertainty about best place for treatment

– reduction in the belief patients who self harm do so for attention

– increased empathy for people with personality disorder

Participants free text commentary– Information was understandable/well pitched– Good sharing knowledge with others e.g. inpatient

and community colleagues– Realising it is OK to feel frustrated!helps– Helpful to link behaviours and personality traits– Helpful to identify how patients feel & why– Extended training & development of local network

please– Good having Time to - Stop Think and Reflect– Best bit - understanding my own feelings and why

I do what I do

Conclusions• Staff rated the workshops highly

• They showed positive changes in their attitude and greater confidence

• Demonstrated increased willingness to express their own difficulties

• Increased motivation for further training opportunities and to develop a local network

What next?• Strategy for training - linking with other

training initiatives

• Follow on from the three days on exploring formulation and therapeutic interventions

• Ensure training links with service developments & local university modules

• Developing an infrastructure to support staff through training, supervision and local forums